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Abstract: Sacral fracture is usually caused by a fall and landing on the hip. This patient had an accidental fall and landing on the hip during running, producing a sacral fracture, which was finally confirmed by radiological examination. Since the fractured end of the sacrum was relatively stable, conservative treatment was adopted. After the conservative treatment, the pain symptoms gradually disappeared and the patient resumed normal life.
[Basic information] Male, 50 years old
Type of disease】Sacral fracture
Hospital】Harbin First Hospital
Date of consultation】04/2021
Treatment plan】Conservative treatment (absolute bed rest, oral ibuprofen extended-release tablets, local cold compresses, infrared therapy)
Treatment period】7 days of inpatient treatment, 1 month and 2 months of outpatient review
Treatment effect】Fracture healing, pain elimination
I. Initial consultation
The patient Mr. Liu fell down accidentally during running exercise, which caused direct local force to the sacrum, and under the action of external force, a sacral fracture occurred, resulting in severe local pain in the sacrum with numbness, limitation of movement and local fracture deformity, and the fracture of the sacrum was confirmed by X-ray film, and the alignment of the fracture end was still well maintained without serious dislocation. The patient was advised to adopt conservative treatment, and the patient expressed the wish to undergo surgery to achieve healing as soon as possible. I told the patient that although surgery could accurately reset and fix the fracture end, the surgery itself could cause damage to the surrounding tissues and destroy the blood supply to the periosteum, which might lead to difficulty in fracture healing or even non-healing, and that the surgery index was not reached according to the examination results. Surgical treatment of sacral fracture is often indicated for severe displacement of the sacrum, or long-term pain after fracture, which affects normal life and work, or sacral fracture combined with neurological symptoms such as sciatic nerve injury, which requires internal fixation treatment with titanium plate screws for incisional nerve reduction fracture. The patient expressed his understanding and agreed to be admitted to the hospital for conservative treatment.
II. Treatment process
Conservative treatment required the patient to rest absolutely in bed, maintain lateral position, and avoid supine position to reduce the pressure stimulation on the fracture site. I gave the patient oral ibuprofen extended-release tablets to relieve pain and inflammation, and applied cold compresses for 72 hours to relieve swelling and pain. This was supplemented with infrared therapy to promote local blood circulation and promote bone healing. After the patient’s pain was relieved, I instructed the patient to leave the bed appropriately to speed up fracture healing and prevent bed rest complications such as decubitus ulcers and venous thrombosis of the lower extremities, and to avoid being sedentary.
III. Treatment effect
Through conservative treatment, the sacral fracture healed smoothly and the patient was discharged after 7 days of hospitalization. The patient indicated that the pain symptom improved significantly around 3 weeks after the telephone call, and gradually resumed normal activities after 3 weeks, but strictly limited participation in sports; the review X-ray confirmed that the fracture line gradually blurred around 4 weeks, and the patient could rest in supine position around 6 weeks, and no pain symptom was induced after the fracture site was compressed, and gradually resumed light sports. completely disappeared, the patient resumed normal movement and normal life was not affected in any way.
IV. Notes
We are glad that the patient received timely diagnosis and treatment after the occurrence of sacral fracture, so the sacral fracture healed well without sciatic nerve injury and without delayed healing, deformed healing or non-healing of sacral fracture. However, patients need to pay attention to avoid local trauma to the sacrum such as direct impact after discharge, which may affect fracture healing. In addition, proper nutrition and daily supplementation of nutrients such as milk or yogurt are beneficial to calcium absorption and to promote smooth healing of sacral fracture. If the patient has symptoms such as swelling, pain and limitation of activity in the sacrum after discharge from the hospital, he should follow up with the orthopedic clinic in time.
V. Personal insight
Most of the sacral fractures occur due to direct trauma, while the weakening of bone strength and degenerative changes in the bones of patients are often the pathological basis for the occurrence of sacral fractures. In addition to preventing traumatic injuries during sports and strengthening the bone strength of sacrum, patients also need to strengthen the exercise of local soft tissues around sacrum, such as appropriate daily self-weight or weight-bearing squatting exercises for 30-60 minutes, so that the local muscles and ligaments of sacrum can be fully exercised to protect sacrum, especially to reduce the force on sacrum in case of fall injury.